Quality Update for December 17, 2004

Cost Remains Biggest Barrier to HIT Adoption, Study Says Rural Association Appoints Forrest Calico to Lead New Quality Initiative Hospital Infection Control Staff Are Spread Too Thin, VHA Study Says Consumer Health Education Books Published VHA Patient Safety Center Creates Hand Hygiene Kit Consumer Union Offers Site to Compare Drug Effectiveness, Prices Cost Remains Biggest Barrier to HIT Adoption, Study Says Physicians are embracing health information technologies ( HIT ) at a slower pace than expected due in large part to the high costs associated with implementing these practices, reports a study in today's issue of Medscape General Medicine, the online, peer-reviewed medical journal published by Medscape. A survey of 1,837 physicians across the country between March and May 2003 found that only a quarter practice in an office where technology is used routinely to improve operational efficiency and clinical care. The survey, conducted by researchers at the Commonwealth Fund, found that the only information technology used routinely by physicians is electronic billing. The size of a physician practice and mode of compensation are the two key variables that predict use of IT, the study, “ Information Technologies: When Will They Make It Into Physicians' Black Bags?” found. "There remains a technological divide between physicians depending on their practice environment and mode of compensation," said Dr. Anne-Marie Audet, lead study author and assistant vice president for quality improvement at the New York-based Commonwealth Fund. This is a major discrepancy that will need to be addressed, she said, since three quarters of U.S. physicians provide care in solo and small group practices, where IT is seldom used. To spur wider adoption among physicians, policymakers will need to focus on ways to make IT tools accessible and affordable to all physicians, the authors said. The survey found: More than 75% of physicians use electronic billing routinely or occasionally but far fewer make use of IT to improve practice efficiency and quality or to communicate with other physicians or patients; 59% of physicians report electronically accessing patients test results either routinely or occasionally; About 27% use an electronic medical record routinely or occasionally; most often for electronic access to lab results but also for access to other decision aids, such as alerts to prevent drug ordering errors; One-quarter electronically order tests, procedures, or drugs at times, but only 17% do it routinely; 54% send reminders to patients regarding routine check ups or preventive care but only 21% do this electronically. Despite widespread use in their personal lives, the study found that very few physicians use e-mail for routine communication with other physicians or their patients. According to the survey, 87% of large group practice physicians can access test results electronically versus 36% of physicians who practice independently. For more info, www.cmwf.org/publications/publications_show.htm?doc_id=251984. Back to top Rural Association Appoints Forrest Calico to Lead New Quality Initiative The National Rural Health Association (NRHA) announced Dec. 2 that Dr. Forrest Calico, will lead a five-year effort to promote access to coordinated, high quality care in every rural community. Calico is past president of Appalachian Regional Healthcare, Inc., and most recently served as Health Systems Advisor for the Federal Office of Rural Health Policy. The new NRHA Quality Initiative will focus helping all rural community-based health care delivery systems cover the continuum of care; achieve optimal quality/performance standards; be financially viable; continuously improve performance and quality; and address population health measures. The Quality Initiative will disseminate and promote the recommendations of the recent Institute of Medicine report, Quality Through Collaboration: the Future of Rural Health, and contribute to the collection of proven models that work for rural areas. For more info, www.raconline.org/news/news_details.php?news_id=2060. Back to top Hospital Infection Control Staff Are Spread Too Thin, VHA Study Says VHA Inc., the health care cooperative that serves not-for-profit hospitals and health systems across the country, has surveyed infection control specialists at member organizations and discovered that infection control resources are stretched very thin in some hospitals. VHA concluded that d evoting more staff to infection control activities in hospitals will reduce infections and have a significant clinical and financial benefit, given that health care-associated infections have a significant economic, social and clinical cost. "With an increased emphasis on hospital infections as part of a national emphasis on improving health care quality and the emergence of SARS, the potential for bioterrorism and concern about a flu epidemic, infection control is very important,” said Dr. John Hitt, vice president of clinical improvement for VHA. Industry experts say that hospital-acquired infections cost the nation $7 billion annually. VHA’s survey indicated: About one in three hospitals had fewer than the recommended ratio of infection control staff to patient beds; Four areas consumed 64% of the infection control staff members’ time: surveillance (26%), communications/management issues, (14%), transmission prevention (12%) and education and training (13%); Surveillance was mostly frequently conducted monthly for catheter- related bloodstream infections, catheter-related urinary tract infections and ventilator-associated pneumonia, and less frequently for antimicrobial use and resistance; The most common areas of focus for infection control teams were surgical infection prevention, hand hygiene, catheter-related bloodstream infection and ventilator-associated pneumonia; The two biggest obstacles to performing better were insufficient resources and lack of physician support. For more info, www.vha.com. Back to top Consumer Health Education Books Published The Health Education Division of MMI of Ardmore has published a series of six consumer health education brochures. “What To Do Before...” presents consumer information in a series of six brochures that use a question & answer format, addressing topics such as Informed Consent, Handwashing, Catheters, Surgical Site Wounds, Intravenous Lines and Antibiotics. “We chose the question and answer format because we want the brochures to have a conversational tone. Consumers respond better and retain information longer when you present the material in a reader-friendly format,” said Dr. Maryanne McGuckin, president of MMI. The MMI consumer education program also offers a wallet-size hospital reminder card that can be used as a quick reference when someone is hospitalized. While intended for consumers, “What To Do Before…” is designed to be purchased and distributed by insurance companies, employers and business health care coalitions, managed care plans, community health centers, physicians’ offices, pharmacies, disease management services, public health departments, libraries, health clubs, senior centers, hospitals, ambulatory health care facilities as well as schools and colleges. “What To Do Before…” is also available in a PDF format. For more info, www.whattodobefore.com. Back to top VHA Patient Safety Center Creates Hand Hygiene Kit The VHA National Center on Patient Safety has developed a new kit on hand hygiene. The site contains information on the VHA public health and hand hygiene campaign for the cold and flu season. For more info, www.publichealth.va.gov/infectiondontpassiton. Information on implementation of the VA hand hygiene policy is contained in the December 2003/January 2004 edition of the TIPS newsletter (Topics in Patient Safety) which can be found at www.publichealth.va.gov/infectiondontpassiton. Back to top Consumer Union Offers Site to Compare Drug Effectiveness, Prices Consumers Union, publisher of Consumer Reports magazine, has launched an educational and outreach initiative and free website, www.CRBestBuyDrugs.org, that will compare a variety of prescription drugs on price, effectiveness and safety to help consumers and their doctors identify the most effective and affordable medicines. The first reports to be released compare drugs in three widely-used categories: cholesterol-lowering medication, heartburn and acid reflux treatments, and anti-inflammatories commonly used to treat arthritis. “Consumer Reports Best Buy Drugs” eventually will compare approximately 20 categories of the most widely used drugs based on price and scientific evidence. When justified by the evidence, the organization will choose a “Best Buy Drug” in a given category. “Consumer Reports Best Buy Drugs” combines evidence-based research on the comparative effectiveness and safety of prescription drugs with national-level data on drug prices. The information on drug effectiveness is derived from the Drug Effectiveness Review Project (DERP), which used teams of physicians and researchers at the Oregon Health & Science University Evidence-based Practice Center. The project compiles drug effectiveness data for states to shape prescription drug coverage choices for their Medicaid programs. Drug price information used by CU is based on average retail prices paid in cash by consumers at the pharmacy. The CU reports are peer-reviewed by medical experts in the particular drug category. In addition to the website, “Consumer Reports Best Buy Drugs” will do significant outreach to physician, pharmacist, senior and low-income groups to help ensure the information gets into their hands. The initial outreach campaign will launch in Atlanta and Sacramento early next year and then will expand to California, Georgia, and other states later in 2005. Among the groups that have agreed to partner with Consumers Union to help disseminate the information are the American Public Health Association, the Alliance for Retired Americans, the National Committee to Preserve Social Security and Medicare and the American Medical School Association. For more info, www.PrescriptionforChange.org. Back to top

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